Organization
CHARLES J. MCMULLIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS BETH E. CARLILE (BILLING MANAGER)
(573) 364-2227
Entity
Organization
Contact information
Practice address
54 HOSPITAL DR, SUITE 205, OSAGE BEACH, MO 65065-3050
(573) 302-2276
Mailing address
54 HOSPITAL DR STE 205, OSAGE BEACH, MO 65065-3050
(573) 302-2276
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD117270
MO
Other
Enumeration date
10/19/2007
Last updated
10/19/2007
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